How a denial is worked
From the codes on the remit to a letter your biller approves, or a plain reason why an appeal will not work.
Denials and appeals in the docs →- Step 1The denial arrives
- On a remit or a status change. Daybook reads the CARC and RARC codes on it.
- Step 2Sorted by cause
- Authorization, eligibility, coding, timely filing, duplicate and more, each with a recommended next step and the appeal deadline from the payer's published policy.
- Step 3Your rules act
- Route by cause: appeal, correct and resubmit, ask the payer, bill the patient or the secondary, or a write-off recommendation. A rule of your own can start a portal attachment task for missing records or a payer call for appeal status.
- Step 4The appeal, drafted
- Code fills in every amount, date and code in the letter, and the language model writes only the connecting sentences and never sees a figure or a patient identifier. When an appeal will not work, Daybook says so instead of drafting one. Your billers approve every appeal before it is sent.
For medical billers
Denials land on one board with four tabs, To work, Waiting, With payer and Answered, each row banded Late, Today, This week or Later, and the tally leads with the late items. For a no-authorization or non-covered denial Daybook walks the cause step by step, from the authorization on file to the provider's credentialing on the date of service to the patient's remaining benefits. Everything else follows your playbook, run as fixed rules.
- Every denial on one board, banded by deadline, with follow-up dates kept two business days before the payer's limit
- The authorization on file checked against the claim, its dates, provider, units and number, for every no-authorization denial
- A corrected claim proposed with frequency code 7 and the original claim number, for your billers to send
- Leads get a breakdown by owner, payer, reason and practice, and open AR in five age buckets with the share over 90 days
- Before a claim goes out, a scrub checks that the authorization is on file and that the provider was credentialed on the date of service
More for medical billers: the billers page and denial management software for billing companies.
For dental billers
Each dental denial comes with its cause, and Daybook drafts the appeal for your biller to approve. The agent says the claim was denied and why, and your biller decides whether to correct it, appeal it or write it off. Before a claim leaves, a scrub reads it for missing fields and the agents check its attachments.
- Each denial sorted by cause, with its appeal deadline
- An appeal drafted to fit the denial, approved by your biller before it is sent
- A pre-submission scrub that reads each dental claim for missing fields and checks its attachments before it leaves
- Your own rules on the cause, such as an attachment task for missing records or a payer call for appeal status
More for dental billers: the dental page.
Starts from your knowledge base
Your billing company's own rules, appeal workflows, payer quirks and call scripts are what Daybook runs. You send the documents, Daybook imports them as payer guides, shows you what it produces, and you adjust it together on a call. Each solution runs on its own, so you start with one and add the next.
For denials that is your appeal workflows: the cause each code maps to, the next step, and the letter your billers send.
- Your playbook for each denial cause, run as fixed rules
- Your appeal letters and the deadlines you keep
- Which denials go to a portal task, a call or a write-off recommendation
Where it shows up
- The claim in your PM or EHR
- The cause, the next step and the appeal deadline
- A signed webhook
- denial.classified and appeal.drafted
- The Daybook dashboard
- The denials board: To work, Waiting, With payer and Answered
- The shared channel
- A denial your rules do not cover, for a decision together
Work denials from your own system
Each denial arrives read and sorted by cause, with its next step and deadline, as a signed webhook. The appeal draft is one call away, and your rules decide what runs on each cause.
Read denials and appeals in the docs →Frequently asked questions
What billing teams ask us about denials and appeals, and our answers.
Does Daybook send appeals to payers on its own?
No. Daybook drafts each appeal and your billers approve every one before it is sent. The same goes for a corrected claim: Daybook proposes it, with frequency code 7 and the original claim number, and your billers send it.
Does an AI model decide whether a denial is appealable?
No. The cause comes from the CARC and RARC codes and your playbook, run as fixed rules, and the appeal window comes from the payer's published policy. When an appeal will not work, because a corrected claim is the remedy or the deadline has passed, Daybook says so with the reason instead of drafting one.
Are appeals written from a template or for each claim?
Both. Daybook drafts each appeal to fit the denial, timely filing and coding denials each in their own format. Code fills in every amount, date and code, and the language model writes only the connecting sentences and never sees a figure or a patient identifier.
Which denials does Daybook sort?
Authorization, eligibility, coding, timely filing, duplicate and more, each with a recommended next step: appeal, correct and resubmit, ask the payer, bill the patient or the secondary, or a write-off recommendation. The write-off itself is always your billers' call.
Can our own rules act on a denial?
Yes. A rule can act on the cause, such as a portal attachment task for missing records or a payer call for appeal status, and every denial carries its appeal deadline.
How is this different from claim status checks?
Claim status tells you a claim was denied. Denials and appeals tells you why, what to do next and by when, and drafts the letter. The two run together: a denial on a 277 or an 835 flows straight into the cause sort.